COVID-19 CONTACT TRACERS

PERFORMANCE MONITORING OF WEEKLY ACCOMPLISHMENTS

Name of Contact Tracer: _______________________________________________________________ CT ID No.: __________________________________

Field Assignment: Barangay, Municipality/City: ___________________________________ Region: NATIONAL CAPITAL REGION Period Covered: ________________________________________
DATES (mm/dd)
WORK/ACTIVITY (2) TOTAL REMARKS
# (as of Friday-5PM)
(1) (3) (4)

Number of case interviews/profiling/initial public health risk assessments of COVID-19 cases

1 and their identified close contacts conducted
Number of close and general contacts traced, profiled and referred to LESO and/or isolation
2 facilities

3 Number of challenging/complex cases/incidents/outbreaks reported to Team Leader (TL)

4 Number of daily monitoring of close and general contacts conducted for at least 14 days

5 Number of cases/reports encoded in the authorized application/system

6 Number of submitted accomplished prescribed form for close contacts/contact tracing

7 Number of laboratory samples collected (if applicable or authorized)

Reported surveillance activites on violation of the minimum health standards i.e. physical
8 distancing, wearing of face masks & face shields, etc.

9 Number queries on COVID-19 responded

Number of relevant health education/instructions to confirmed COVID-19 cases and contacts
10 conducted per DOH protocols
Number of relevant Briefings/Seminars/Meetings attended and provided inputs to
11 protocols/guidance and standard operating procedures
Number of collaboration activities with other government agencies/private sector for enhanced
12 contact tracing
Completed and submitted accurate, up-to-date records of contacts/action and accomplished
13 relevant records and compliance with team handover procedures

14 Performed other instructions/tasks provided by LESO/Team Leader/City Director/MLGOO

Prepared and submitted by: Verified by: Noted by:
_______________________________________________________________ _____________________________________________________________ __________________________________________________
Name & Signature Name and Signature of LESO/Team Leader Name and Signature of City Director/MLGOO

Receiving Officer:______________________________ Date: ______________________

* LESO - Local Epidemiological Surveillance Officer

Instructions:
Notes: 1. Add additional rows to capture other activities conducted other than those listed.
Column 1. Indicate the relevant contact tracing activity conducted per TOR 2.The form will be submitted weekly to the DILG City Director/MLGOO but the entries will reflect daily record of
Columns 2. Write the dates when the activity/report was conducted/submitted. accomplishments.
Column 3. Write the total accomplishments for the week as of 5:00 PM (Friday)
Column 4. Write the patients' number/s, significant observations/clarifications, etc.